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The hard truth about Alzheimer’s drugs

Aricept, Exelon, and Razadyne do little to help most people and pose risks

Published: April 16, 2014 03:00 PM

Alzheimer’s disease, the most common form of dementia, is a terrible thief. Over time it robs people of their ability to remember, learn, and reason, cutting them off from friends and family and eventually even their own sense of self. The companies that sell Alzheimer’s drugs peddle hope to people looking for a way to ease the pain and frustration. But a hard look through the research paints a far more disappointing picture.

Marketing for the Exelon Patch reassures people that the active ingredient “has been studied for over a decade in clinical trials” and that it has “been shown to benefit cognition, which includes things like memory, reasoning, understanding, and communication, as well as improve overall function.” Marketing for Aricept characterizes giving the drug to a loved one as an act of responsibility and caring. “I want to give to the man who gave me so much love,” says a woman as she kisses the cheek of an older man.

It’s true that Alzheimer’s drugs have undergone extensive study. But the overall results are far less encouraging than the ads portray. Most people who take them don’t experience a meaningful benefit. More than half experience side effects. And they’re expensive, costing anywhere from $140 to more than $656 monthly.

And through it all, the thief continues unchecked—none of the drugs can reverse the disease.

“Unfortunately, studies consistently show that for the typical patient, the Alzheimer’s drugs on the market slow the decline of memory, learning, and reasoning by only a modest amount," Steven Woloshin, M.D., professor of medicine at the Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, said. "And they can cause bothersome and potentially serious side effects. Unfortunately, the drugs don’t affect the progression of the underlying disease.”

To clearly spell out the risks and benefits of these medications, Consumer Reports Best Buy Drugs commissioned Informulary, a company founded by Woloshin and another Dartmouth professor, Lisa Schwartz, M.D., to review the evidence for three drugs approved by the Food and Drug Administration to treat mild-to-moderate Alzheimer’s—donepezil (Aricept and generic), galantamine (Razadyne and generic) and rivastigmine (Exelon patch, Exelon capsules, and generic). Their analysis is summarized in Drug Facts Boxes (see separate links above), which are similar to the Nutrition Facts found on packaged foods.

The Drug Facts Boxes reveal that after six months on the drugs, most of the patients show no improvement in mental functioning, based on their doctors’ assessments and tests of basic thinking skills. Among the few who do benefit, the improvement is typically slight. “The available studies have not shown that the drugs help achieve what we would consider major goals of dementia treatment, prolonging people’s ability to live independently or improving quality of life for either patients or caregivers,” Woloshin said.

Even a small benefit or chance of improvement might be worth it if Alzheimer’s drugs were risk free. But they are not. They can cause side effects such as insomnia, nausea, muscle cramps, diarrhea, and reduced appetite, all of which can be troublesome for people with dementia. Rarely, the drugs may cause more serious side effects such as internal bleeding and a slowed heart rate that could be potentially dangerous.

Of course, the decision on whether you or a loved one who is affected by Alzheimer’s disease should use a medication is a personal one. Patients and their families who decide to try a drug could start with generic donepezil, which is not more effective than other drugs, but is one of the less expensive choices and has a lower rate of side effects. If there’s no improvement in symptoms after a few months, it makes sense to consider tapering and stopping the drug.

If treatment is continued, people should be reluctant to tolerate a lot of side effects and should stop the drug when the disease has progressed substantially—for example, to the point that a patient requires institutionalization.

—Teresa Carr

Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).